Effect of Glycemia on Plasma Incretins and the Incretin Effect During Oral Glucose Tolerance Test

1Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio

2Cincinnati Veterans Administration Medical Center, Cincinnati, Ohio

Corresponding author: Marzieh Salehi, salehim{at}uc.edu.

Abstract

The incretin effect, reflecting the enhancement of postprandial insulin secretion by factors including the intestinal hormones
glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide, increases in proportion to meal size. However,
it is unknown whether the incretin effect is dependent on ambient glucose. The goal of this study was to determine the effect
of plasma glycemia on the incretin effect. Thirteen healthy subjects consumed 50 g oral glucose solution mixed with d-xylose during fixed hyperglycemia at 8 and 10.5 mmol/L, on 3 separate days, twice at lower glycemia (LOW) and once at higher
values (HIGH). The relative increase in insulin release after glucose ingestion at fixed hyperglycemia, a surrogate for the
incretin effect, was similar among all three studies. The GLP-1 response to oral glucose was significantly lower at higher
plasma glycemia, as was the appearance of d-xylose after the meal. Between the two LOW studies, the reproducibility of insulin release in response to intravenous glucose
alone and intravenous plus ingested glucose was similar. These findings indicate that the incretin contribution to postprandial
insulin release is independent of glycemia in healthy individuals, despite differences in GLP-1 secretion. The incretin effect
is a reproducible trait among humans with normal glucose tolerance.